On November 18, 2015, the U.S. Department of Labor (“DOL”) published proposed amendments to the claims procedure regulations under ERISA with respect to claims for disability benefits. Generally, these amendments have the effect of extending to disability benefit claims several of the procedural protections that were added by the Affordable Care Act for health benefit claims, particularly regarding internal claims and appeals under group health plans (e.g., providing expanded benefit denial notices written in a culturally and linguistically appropriate manner). If the proposed regulations are adopted as final, administrators of plans providing disability benefits would be required to implement these enhanced claims and appeals procedures. The proposed regulations are available here.
ACA Final Regulations on Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, and Other Matters
The U.S. Departments of Health and Human Services, Labor, and the Treasury jointly issued final regulations on November 18, 2015, addressing a variety of topics under the Affordable Care Act (“ACA”), including, (1) the preservation of grandfathered plan status, (2) the prohibition on preexisting condition exclusions, (3) the prohibition on lifetime and annual dollar limits for essential health benefits, (4) the prohibition on rescissions of coverage, (5) the extension of certain dependent child coverage to age 26, (6) internal claims and appeals and external review rules, and (7) certain patient protection rules (including rules regarding the designation of a primary care physician and coverage for emergency services). These final regulations primarily combine previously issued proposed and interim final regulations, posted ACA FAQs, technical notices and other informal guidance for each of these topics with relatively few noteworthy changes for employer-provided group health plans. The final regulations will generally be effective… Continue Reading
President Obama recently signed into law the Bipartisan Budget Act of 2015, legislation which includes several provisions that impact defined benefit pension plans. First, the act increases PBGC premiums for single-employer pension plan sponsors and accelerates the premium due date for plan year 2025 by one month. Second, the act permits pension plan sponsors to apply to the U.S. Treasury Department for plan years after 2015 to use custom mortality tables based on plan experience and projected trends on mortality, which could improve funding levels if alternative tables more accurately represent their experiences. Lastly, the act extends for three years defined benefit pension plan funding stabilization provisions originally included in the Moving Ahead for Progress in the 21st Century Act (“MAP-21″) in 2012 and extended in the Highway and Transportation Funding Act of 2014 (“HATFA”). The act can be found here.
The recently enacted Bipartisan Budget Act of 2015 repeals Section 18A of the Fair Labor Standards Act of 1938 (the “FLSA”). The repealed provision, which was added by Section 1511 of the Patient Protection and Affordable Care Act, would have required employers with more than 200 full-time employees to automatically enroll new employees (and continue enrollment of existing employees) in a health benefits plan offered through the employer. Prior to its repeal, enforcement of Section 18A of the FLSA had been delayed pending issuance of implementing regulations by the U.S. Department of Labor. The Bipartisan Budget Act of 2015 is available here.
On October 30, 2015, the U.S. Equal Employment Opportunity Commission (the “EEOC”) issued proposed regulations amending previously issued proposed regulations under Title II of the Genetic Information Nondiscrimination Act of 2008 (“GINA”) regarding employer wellness programs. Among other items, the proposed regulations explain that wellness programs that request or require employees (or their covered spouses) to provide genetic information as part of health or genetic services (e.g., through a health risk assessment (“HRA”) involving a medical questionnaire or medical examination) must be reasonably likely to promote health or prevent disease. Furthermore, the proposed regulations clarify that GINA does not prohibit employers from offering limited inducements to employees whose spouses (who are covered under the employer’s group health plan) complete an HRA under which genetic information is provided, subject to the requirements that the provision of such information by the spouse is voluntary and that prior written authorization is obtained from… Continue Reading
On October 23, 2015, the U.S. Departments of Labor (“DOL”), Health and Human Services (“HHS”), and Treasury issued a set of Frequently Asked Questions (“FAQs”) addressing certain provisions under the Affordable Care Act (“ACA”) and Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”). The FAQs provide guidance on several topics, including coverage of preventive services, wellness programs, and required disclosures under the MHPAEA. The FAQs can be found here.
The IRS recently published proposed regulations that would amend various sections of the Internal Revenue Code in light of two U.S. Supreme Court rulings that upheld the validity of same-sex marriages: Windsor v. United States (2013) and Obergefell v. Hodges (2015). The IRS proposes that, for federal tax purposes, the terms “spouse,” “husband,” and “wife” shall mean an individual lawfully married to another individual and the term “husband and wife” shall mean two individuals lawfully married to each other, regardless of sex. Such terms will not include individuals who have entered into a domestic partnership, civil union, or any other similar relationship recognized by state law that is not denominated as a “marriage” under state law. The proposed regulations can be found here.
The IRS recently announced cost-of-living adjustments for 2016, which leave many key plan limits unchanged. The following is a list of some key annual limits that will apply to qualified retirement plans in 2016: Elective deferrals to 401(k) and 403(b) plans: $18,000. Annual additions to a defined contribution plan: $53,000. Catch-up contributions for employees aged 50 and over to 401(k) and 403(b) plans: $6,000. Annual benefit limit for a defined benefit plan: $210,000. Compensation dollar limit for defining a “key employee” in a top heavy plan: $170,000. Compensation dollar limit for defining a “highly compensated employee”: $120,000. Compensation limit in calculating a participant’s benefit accruals: $265,000. The full list of 2016 plan limits can be found in IRS Information Release 2015-118 here.
For the Affordable Care Act’s 2015 Transitional Reinsurance Program (the “Program”), the Centers for Medicare and Medicaid Services recently released the “Annual Enrollment and Contributions Submission Form Manual” (the “Manual”). The Manual describes the steps a Contributing Entity (or a third party on behalf of a Contributing Entity) must follow to submit the required forms and make the payments required under the Program. Annual enrollment counts and other required information (including supporting documentation, if applicable) must be submitted on the prescribed form by Monday, November 16, 2015. The Transitional Reinsurance Fee, which is equal to $44 per covered life, is due either (1) in a single payment made on or before January 15, 2016, or (2) in two installments due by January 15, 2016 and November 15, 2016, respectively. The Manual is available here.
A federal district court recently held that an employer’s requirement for an employee to produce a marriage license as a condition to covering his spouse under the employer’s health plan did not run afoul of the prohibition against employment discrimination on the basis of religion under Title VII of the Civil Rights Act of 1964 (“Title VII”). The employee claimed that obtaining a marriage license was contrary to his Islamic beliefs. This case is noteworthy because the rejection of the employee’s Title VII claim was based on the fact that a marriage license was required of all employees, regardless of their religious beliefs. Employers that require proof of marriage from only a subset of employees, such as only from employees seeking to cover their same-sex spouses under a group health plan, are at risk for claims of discrimination in violation of Title VII (or similar state laws), which expressly prohibits… Continue Reading